Data processing

On receipt of the completed questionnaires, all non-English responses were translated into English. Survey responses were checked for consistency and other errors, and countries were contacted for follow-up to ensure accurate reporting of results. Data were exported from DataCol in Microsoft Excel format and the data analysis was performed using R statistical programming language.4 _{Data were analysed by thematic section: for closed-ended questions, percentages}

were computed for each possible response to obtain the global level results. In addition, the data were aggregated and analysed by WHO region and World Bank income group to see trends by these groupings (Table 2). Preliminary analysis based on aggregation by ICT Development Index5 _{showed similar results as for those by World Bank income group; this is due to the high}

correlation between ICT Development Index and GDP per capita (Spearman ρ=0.96, p<.001). Therefore, these results were not included in this report. Cross-question analysis was performed where two or more questions were thought to be related, such as countries having introduced complementary policies, and the results were probed in greater depth as warranted. External health and technology indicators, such as mobile phone penetration, were introduced into the analysis for comparison purposes where relevant.

Results from the current survey were compared to those from the previous survey wherever possible; however, as the subject matter covered by the 2009 survey was considerably broader, and the survey questions were worded somewhat differently, there was little scope for this sort of analysis. In addition, the percentages in the 2009 survey were often not directly comparable, particularly at the regional level, as the sets of responding countries differed, as did the expert informants responding in each iteration of the survey.t

Table 3. Response rate by WHO region

Grouping Advantage Disadvantage

WHO region WHO regional approach integrated into WHO strategic analysis, planning, and operational action.

Limited country commonality from an economic, health care, or ethnic perspective.

Less useful for other agencies or institutions wishing to interpret or act on GOe data.

World Bank income group

Clear economic definition based on GNI per capita.

Consistent application of criteria across all countries.

Simple four-level scale.

Does not account for income

disparity, health of the population, or population age.

GNI, gross national income.

4 http://www.r-project.org/. 5 http://www.itu.int/ITU-D/ict/publications/idi/2009/index.html. G O E S E C O N D G LO B A L S U R V E Y O N E H

Response rate

Not all Member States completed all seven sections of the survey: 112 completed it entirely and 114 (59% of Member States; 81% of the world’s population) completed at least one section (the Telemedicine Section). The response to the 2009 survey is roughly the same as for the previous global survey (58%), which is encouraging considering the 2009 survey instrument is significantly longer than that of 2005/2006. Figure 3 shows the countries that answered the Telemedicine Section of the survey. Tables 4 and 5 show the distribution of those countries by WHO region and World Bank income group, respectively.

Figure 3. Responding WHO Member States

Response rate by WHO region

Administratively, WHO is made up of six geographical regions. The regions are heterogeneous: Member States differ with respect to size, economy, and health care challenges. Nevertheless, it is still important to present high-level eHealth analyses at the regional level as this reflects the organizational structure and operational framework of WHO.

Table 3 shows considerable variation in country participation: for example responses ranged from 34% (in the Region of the Americas) to 73% (the South-East Asia Region). Numerous Member States indicated that they would not be able to participate in the 2009 survey due to resources being diverted to prepare and respond to the H1N1 pandemic, or due to other urgent public health issues arising from armed conflicts; this was the case with many countries from the region of the Americas. The Western Pacific Region has many small island Member States of which only a few responded to the survey, yielding a response rate of 48% for this region. The response rates for the Eastern Mediterranean, African and European Regions were over 60%. This was particularly encouraging for regions consisting of a large number of Member States such as the African and European Regions.

O N D G LO B A L S U R V E Y O N E H E A LT H

Table 3. Response rate by WHO region

WHO region

Africa Americas _{East Asia}South- Europe _{Mediterranean}Eastern Western _Pacific Total number of countries 46 35 11 53 21 27 Number of responding countries 31 12 8 36 14 13 Response rate 67% 34% 73% 68% 67% 48%

Response rate by World Bank income group

The World Bank classifies all economies with a population greater than 30 000 into four income groups based on gross national income (GNI) per capita.6 _{The classification is as follows: low income}

(US$ 975 or less); lower-middle income (US$ 976–3855); upper-middle income (US$ 3856–11 905); and high income (US$ 11 906 or more).7 _{These income groups are a convenient and practical}

basis for analysis to look at trends in the survey results based on income level. Classification by income does not correspond exactly to level of development; however, low- and middle-income countries are sometimes referred to as ‘developing’ economies and high-income countries as ‘developed’ for convenience.

Table 4 shows the survey response rate by World Bank income group. Low-income countries had the highest response rate (70%), closely followed by high-income countries (63%). In terms of raw numbers, the distribution of responding countries was remarkably even, with 30 to 32 countries responding from the high-income, lower-middle income, and low-income groups; slightly fewer countries responded from the upper-middle income group.

Table 4. Response rate by World Bank income group

World Bank income group

High income Upper-middle _income Lower-middle _income Low income Total number of countries 49 44 53 43 Number of responding countries 31 21 32 30 Response rate 63% 48% 60% 70% 6 http://data.worldbank.org/about/country-classifications. G O E S E C O N D G LO B A L S U R V E Y O N E H

Telemedicine results

Analysis of the results of the Telemedicine Section of the second global survey on eHealth 2009 will follow in four areas:

Current state of telemedicine services; 1.

Factors facilitating telemedicine development; 2.

Barriers to telemedicine; and 3.

Telemedicine information needs. 4.